Cardiovascular Morbidity and Mortality of the Metabolic Syndrome

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Cardiovascular disease remains the single leading cause of morbidity and mortality in the United States. The metabolic syndrome has received increased attention in recent years, partly because of the growing prevalence of obesity and its association with cardiovascular disease. This article reviews current evidence from longitudinal observational studies that evaluated the impact of metabolic syndrome on cardiovascular morbidity and mortality in various population subsets. The approach to cardiovascular risk assessment in individuals who have multiple risk factors and the clinical implications of diagnosing the metabolic syndrome are also discussed.

Section snippets

Metabolic risk factors and cardiovascular disease

Central obesity and insulin resistance are the common underlying denominators of MetS, and are thought to manifest as several metabolic risk factors, including atherogenic dyslipidemia, elevated plasma glucose, elevated blood pressure, proinflammatory state, and prothrombotic state [2], [3], [4], [5], [8]. These metabolic risk factors are believed to have a direct effect on atherosclerotic disease.

Risk of cardiovascular disease associated with the metabolic syndrome

The data to support MetS as a risk factor for the subsequent development of CVD are outlined below. Once diabetes emerges, cardiovascular risk increases even further [22]. Summaries of relevant studies described in this article are shown in Table 1.

Part of the difficulty in establishing the diagnosis of MetS is that it lacks a uniformly accepted definition. There are three currently recognized criteria sets, as reviewed separately in this issue. The existence of several diagnostic criteria for

Risk assessment for future development of atherosclerotic cardiovascular disease in individuals who have the metabolic syndrome

To reduce the lifetime risk of ASCVD, all individuals found to have the MetS deserve a comprehensive global risk assessment and long-term monitoring [2]. Individuals who have clinical ASCVD (eg, CHD, stroke, or peripheral artery disease [PAD]) or who have diabetes belong in a high-risk category and should be treated more aggressively with risk factor-targeted pharmacotherapy, in addition to lifestyle intervention to significantly reduce morbidity and mortality. Recommendations from ATP-III and

Clinical implications of diagnosing the metabolic syndrome

The surge of public interest in the MetS and the flux of recent publications on this subject have increased health care providers' interest and understanding of the links between obesity, insulin resistance, and CVD. Although studies examining the short-term predictive value of the MetS do not support its superiority over the Framingham-based risk prediction system, the diagnosis of the MetS remains a strong predictor of CVD risk, and identifies high-risk patients in whom detailed global risk

Summary

CVD remains the most widespread health care problem in the United States. Recently, the MetS has received an increasing amount of attention because of the growing prevalence of obesity and its association with heart disease. Longitudinal observational studies have confirmed that the MetS is a risk factor for the subsequent development of CVD and mortality. Evidence also suggests that women who have MetS are more susceptible to CVD and cardiovascular mortality than men. Identifying patients who

References (72)

  • M. Briand et al.

    Metabolic syndrome negatively influences disease progression and prognosis in aortic stenosis

    J Am Coll Cardiol

    (2006)
  • M.A. Alpert

    Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome

    Am J Med Sci

    (2001)
  • J. Ärnlöv et al.

    Several factors associated with the insulin resistance syndrome are predictors of left ventricular systolic dysfunction in a male population after 20 years of follow-up

    Am Heart J

    (2001)
  • S.C. Smith et al.

    AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute

    J Am Coll Cardiol

    (2006)
  • W. Rosamond et al.

    Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee

    Circulation

    (2007)
  • S.M. Grundy et al.

    Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement

    Circulation

    (2005)
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

    Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report

    Circulation

    (2002)
  • E.S. Ford et al.

    Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey

    JAMA

    (2002)
  • R. Kahn et al.

    The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes

    Diabetes Care

    (2005)
  • J.A. Beckman et al.

    Diabetes and atherosclerosis: epidemiology, pathophysiology, and management

    JAMA

    (2002)
  • M.C. Carr et al.

    Abdominal obesity and dyslipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk

    J Clin Endocrinol Metab

    (2004)
  • R. Carmena et al.

    Atherogenic lipoprotein particles in atherosclerosis

    Circulation

    (2004)
  • H.N. Ginsberg et al.

    Metabolic syndrome: focus on dyslipidemia

    Obesity (Silver Spring)

    (2006)
  • R.L. Hopfner et al.

    Endothelin: emerging role in diabetic vascular complications

    Diabetologia

    (1999)
  • A.G. Nugent et al.

    Impaired vasoconstriction to endothelin 1 in patients with NIDDM

    Diabetes

    (1996)
  • L.A. Suzuki et al.

    Diabetes accelerates smooth muscle accumulation in lesions of atherosclerosis

    Diabetes

    (2001)
  • A.I. Vinik et al.

    Platelet dysfunction in type 2 diabetes

    Diabetes Care

    (2001)
  • A. Ceriello et al.

    Hyperglycemia-induced thrombin formation in diabetes

    Diabetes

    (1995)
  • P.M. Ridker et al.

    C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women

    Circulation

    (2003)
  • A. Festa et al.

    Elevated levels of acute-phase proteins and plasminogen activator inhibitor-1 predict the development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study

    Diabetes

    (2002)
  • P.M. Ridker

    Clinical application of C-reactive protein for cardiovascular disease detection and prevention

    Circulation

    (2003)
  • R.W. Nesto

    Correlation between cardiovascular disease and diabetes mellitus: current concepts

    Am J Med

    (2004)
  • K.G. Alberti et al.

    Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation

    Diabet Med

    (1998)
  • A.M. McNeill et al.

    The metabolic syndrome and 11-year risk of incident cardiovascular disease in the Atherosclerosis Risk in Communities Study

    Diabetes Care

    (2005)
  • H.M. Lakka et al.

    The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

    JAMA

    (2002)
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